6

TLS, have you I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING

transmitted all R Action Date Signature
text files for this INSTRUCTIONS TO PRINTERS
cycle update? FORM 4136, PAGE 1 of 6
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES. PRINTS: HEAD TO HEAD O.K. to print
PAPER: WHITE WRITING, SUB. 20. INK: BLACK
FLAT SIZE: 406mm (16")
279mm (11") folded to 203mm (8")
279 mm (11")
Date PERFORATE: ON FOLD Revised proofs
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT requested

4136
OMB No. 1545-0162
Credit for Federal Tax Paid on Fuels
Form

Department of the Treasury

䊳 See the Instructions on page 3.
2005
Attachment
Internal Revenue Service 䊳 Attach this form to your income tax return. Sequence No. 23
Name (as shown on your income tax return) Taxpayer identification number

Caution: ● Claims for diesel fuel and kerosene (other than kerosene used in aviation) used on a farm for farming pur-
poses on new lines 3e and 4c are made only by the ultimate purchaser after September 30, 2005.
● Claims on lines 5 and 8 for aviation-grade kerosene can be made only for uses or sales before October 1, 2005. See
line 14 and the worksheets in the instructions for claims for kerosene used in aviation after September 30, 2005.
● There are two credit rates in effect for most fuels during 2005. The * rate is applicable after Sept. 30, 2005.
1 Nontaxable Use of Gasoline
(a) Type of use (b) Rate (c) Gallons (d) Amount of credit (e) CRN


a Off-highway business use of gasoline $.184/.183* $
b Use of gasoline on a farm for farming purposes .184/.183* 362
c Other nontaxable use of gasoline .184/.183*
2 Nontaxable Use of Aviation Gasoline
(a) Type of use (b) Rate (c) Gallons (d) Amount of credit (e) CRN
a Use in commercial aviation (other than foreign trade) $ .15 $ 354
b Other nontaxable use .194/.193* 324
3 Nontaxable Use of Undyed Diesel Fuel
Claimant certifies that the diesel fuel did not contain visible evidence of dye.
Exception. If any of the diesel fuel included in this claim did contain visible evidence of dye, attach an explanation; check here 䊳

Caution: Claims for diesel fuel used on a farm for farming

purposes are made only by the ultimate purchaser on line 3e
after September 30, 2005. (a) Type of use (b) Rate (c) Gallons (d) Amount of credit (e) CRN
a Nontaxable use $.244/.243* $ 360
b Use in trains, January 1, 2005 – June 30, 2005
c Use in trains, July 1, 2005 – December 31, 2005
.21
.22  353

d Use in certain intercity and local buses .17 350

e Use on a farm for farming purposes after Sept. 30, 2005 .243 360
4 Nontaxable Use of Undyed Kerosene (Other Than Aviation-Grade Kerosene and Kerosene Used in Aviation)
Claimant certifies that the kerosene did not contain visible evidence of dye.
Exception. If any of the kerosene included in this claim did contain visible evidence of dye, attach an explanation; check here 䊳

Caution: Claims for kerosene used on a farm for farming

purposes are made only by the ultimate purchaser on line 4c
after September 30, 2005. See the instructions for an
exception for kerosene used in aviation. (a) Type of use (b) Rate (c) Gallons (d) Amount of credit (e) CRN
a Nontaxable use $.244/.243* $ 346
b Use in certain intercity and local buses .17 350
c Use on a farm for farming purposes after Sept. 30, 2005 .243 346
5 Nontaxable Use of Aviation-Grade Kerosene Before Oct. 1, 2005
Claimant certifies that the aviation-grade kerosene did not contain visible evidence of dye.
Exception. If any of the aviation-grade kerosene included in this claim did contain visible evidence of dye, attach a detailed
explanation and check here 䊳

Caution: Line 5 applies to claims for aviation-grade kerosene before October 1, 2005. See line 14 and the worksheets in the instructions
for kerosene used in aviation after September 30, 2005.
(a) Type of use (b) Rate (c) Gallons (d) Amount of credit (e) CRN
a Use in commercial aviation (other than foreign trade) $.175 $ 355
b Other nontaxable use .219 369
c Use in foreign trade .044 377
6 Sales by Registered Ultimate Vendors of Undyed Diesel Fuel Registration No. 䊳

Claimant certifies that it sold the diesel fuel at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained written
consent of the buyer to make the claim. Claimant certifies that the diesel fuel did not contain visible evidence of dye.
Exception. If any of the diesel fuel included in this claim did contain visible evidence of dye, attach an explanation and check here 䊳

Caution: Registered ultimate vendors cannot make claims for diesel fuel sold for use on a farm for farming purposes after Sept. 30, 2005.
(a) Type of use (b) Rate (c) Gallons (d) Amount of credit (e) CRN
a Use on a farm for farming purposes before Oct. 1, 2005
b Use by a state or local government
$.244
.244/.243*  $
360

c Use in certain intercity and local buses .17 350

For Paperwork Reduction Act Notice, see the instructions. Cat. No. 12625R Form 4136 (2005)
 6
I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 4136, PAGE 2 of 6
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES. PRINTS: HEAD TO HEAD
PAPER: WHITE WRITING, SUB. 20. INK: BLACK
FLAT SIZE: 406mm (16")
279mm (11") folded to 203mm (8")
279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Form 4136 (2005) Page 2

7 Sales by Registered Ultimate Vendors of Undyed Kerosene (Other
Than Aviation-Grade Kerosene and Kerosene Used in Aviation) Registration No. 䊳

Claimant certifies that it sold the kerosene at a tax-excluded price, repaid the amount of tax to the buyer, or has obtained the written consent
of the buyer to make the claim. Claimant certifies that the kerosene did not contain visible evidence of dye.
Exception. If any of the kerosene included in this claim did contain visible evidence of dye, attach an explanation and check here 䊳

Caution: Registered ultimate vendors cannot make claims for kerosene sold for use on a farm for farming purposes after September 30, 2005.
(a) Type of use (b) Rate (c) Gallons (d) Amount of credit (e) CRN


a Use on a farm for farming purposes before Oct. 1, 2005 $.244 $
b Use by a state or local government .244/.243* 346
c Sales from a blocked pump .244/.243*
d Use in certain intercity and local buses .17 350
8 Sales by Registered Ultimate Vendors of Aviation-Grade Kerosene before Oct. 1, 2005 Reg. No. 䊳
Claimant sold the aviation-grade kerosene at a tax-excluded price and has not collected the amount of tax from the buyer, repaid the
amount of tax to the buyer, or has obtained written consent of the buyer to make the claim.
Caution: Line 8 applies to claims for aviation-grade kerosene before October 1, 2005. See line 14 and the worksheets in the instructions
for sales of kerosene for use in aviation after September 30, 2005.
(a) Type of use (b) Rate (c) Gallons (d) Amount of credit (e) CRN
a Use in commercial aviation (other than foreign trade) $.175 $ 355


b Other nontaxable use .219
c Use on a farm for farming purposes .219 369
d Use by a state or local government .219
9 Sales by Registered Ultimate Vendors of Gasoline Registration No. 䊳

Claimant sold the gasoline at a tax-excluded price and has not collected the amount of tax from the buyer, repaid the amount of tax to the
buyer, or has obtained written consent of the buyer to make the claim; and obtained an unexpired certificate from the buyer and has no reason
to believe any information in the certificate is false. See the instructions for additional information to be submitted.
(b) Rate (c) Gallons (d) Amount of credit (e) CRN
a Use by a nonprofit educational organization $.184/.183* $
362
b Use by a state or local government .184/.183*
10 Sales by Registered Ultimate Vendors of Aviation Gasoline Registration No. 䊳

Claimant sold the aviation gasoline at a tax-excluded price and has not collected the amount of tax from the buyer, repaid the amount of tax
to the buyer, or has obtained written consent of the buyer to make the claim; and obtained an unexpired certificate from the buyer and has no
reason to believe any information in the certificate is false. See the instructions for additional information to be submitted.
(b) Rate (c) Gallons (d) Amount of credit (e) CRN
a Use by a nonprofit educational organization $.194/.193* $
324
b Use by a state or local government .194/.193*
11 Nontaxable Use of Liquefied Petroleum Gas (LPG)
(a) Type of use (b) Rate (c) Gallons (d) Amount of credit (e) CRN
a Use in certain intercity and local buses $.062 $ 352
b Use in qualified local buses or school buses .136 361
c Other nontaxable use .136 395
12 Alcohol Fuel Mixture Credit Registration No. 䊳

Claimant produced an alcohol fuel mixture by mixing taxable fuel with alcohol. The alcohol fuel mixture was sold by the claimant to any
person for use as a fuel or was used as a fuel by the claimant.
(b) Rate (c) Gallons (d) Amount of credit (e) CRN
a Alcohol fuel mixtures containing ethanol $.51 $ 393
b Alcohol fuel mixtures containing alcohol (other than ethanol) .60 394
13 Biodiesel Mixture Credit Registration No. 䊳

Claimant produced a biodiesel mixture by mixing diesel fuel with biodiesel. The biodiesel mixture was sold by the claimant to any person for
use as fuel or was used as a fuel by the claimant. Claimant has a certificate from the producer or importer of the biodiesel which identifies
the percentage of biodiesel and agri-biodiesel in the product, and has no reason to believe the information is false. See the instructions for
line 13 to see if you must attach the certificate.
(b) Rate (c) Gallons (d) Amount of credit (e) CRN
a Biodiesel (other than agri-biodiesel) mixtures $.50 $ 388
b Agri-biodiesel mixtures 1.00 390
14 Kerosene For Use in Aviation After September 30, 2005. See the instructions for worksheets to figure the amount of credit.
(d) Amount of credit (e) CRN
a Use in commercial aviation (other than foreign trade) $ 355
b Sales by registered ultimate vendors 369

15 Total income tax credit claimed. Add lines 1 through 14, column (d). Enter here and on
Form 1040, line 70 (also check box b on line 70); Form 1120, line 32f(2); Form 1120-A, line
28f(2); Form 1120S, line 23c; Form 1041, line 24g; or the proper line of other returns. 䊳 15 $
Form 4136 (2005)

I.R.S. SPECIFICATIONS
INSTRUCTIONS TO PRINTERS
FORM 4136, PAGE 3 of 6
MARGINS: TOP 13mm (1⁄2 "), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
FLAT SIZE: 406mm (16")
279mm (11") folded to 203mm (8") X 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
Form 4136 (2005)
Instructions for Form 4136
Section references are to the Internal Revenue Code.
What’s New
● The reduced rates of excise tax for most alcohol-blended
fuels have been eliminated and the lines for any credits have
been removed.
● The following new credits have been added:
a. Sales by registered ultimate vendors of aviation-grade
kerosene (line 8) before October 1, 2005;
b. Sales by registered ultimate vendors of gasoline (line 9)
and aviation gasoline (line 10) sold to state and local
governments and nonprofit educational organizations;
c. Sales by registered ultimate vendors of undyed diesel
fuel (line 3d) or undyed kerosene (line 4b) sold for use by
intercity and local buses, if the ultimate purchaser waives its
right to the claim;
d. Alcohol fuel mixtures (line 12) and biodiesel mixtures
(line 13); and
e. Kerosene for use in aviation after September 30, 2005 (line
14).
● Fuel used in mobile machinery in an off-highway business
use is limited to an annual claim on Form 4136 for taxable
years beginning after October 22, 2004.
● Effective after September 30, 2005, the ultimate vendor can
no longer make claims for undyed diesel fuel (line 6a) and
undyed kerosene (line 7a) used on a farm for farming
purposes. Claims can be made only by the ultimate purchaser
(the farmer), using lines 3e and 4c. However, claims for
kerosene used in aviation on a farm for farming purposes must
be claimed by the ultimate vendor on line 14b.
● Effective after September 30, 2005, claims cannot be
made for the LUST tax, except for fuel destined for export.
The affected credit rates have been reduced by $.001 to
reflect this change. Two rates are shown on various lines of
Form 4136, the * rate is effective after September 30, 2005.
● Aviation-grade kerosene is eliminated as a type of fuel
effective after September 30, 2005. Lines 5 and 8 are not
applicable after this date. All ultimate purchaser claims for
kerosene used in domestic commercial aviation and all
registered ultimate vendor claims for kerosene used in
noncommercial aviation and foreign trade after September
30, 2005, will be made on line 14. Type of use 11 is not valid
after September 30, 2005.
● Type of use 13 has been added to the type of use table,
exclusive use by a nonprofit educational organization.
● Type of use 14 has been added to the type of use table,
exclusive use by a state, a political subdivision of a state, or
the District of Columbia.
Purpose of Form
Use Form 4136 to claim a credit for certain nontaxable uses
(or sales) of fuel during the income tax year. Also use Form
4136 if you are a producer claiming a credit for alcohol fuel
mixtures or biodiesel mixtures. However, you may use Form
8849, Claim for Refund of Excise Taxes, to claim a periodic
refund instead of waiting to claim an annual credit on Form
4136.
Caution: You cannot claim any amounts on Form 4136 that
you claimed on Form 8849 or Schedule C (Form 720).
Partnerships. Partnerships (other than electing large
partnerships) cannot file this form. Instead, they must include
a statement on Schedule K-1 (Form 1065), Partner’s Share of
6
TO BE REMOVED BEFORE PRINTING
PRINTS: HEAD TO HEAD
INK: BLACK
Page 3
Income, Deductions, Credits, etc., showing the allocation to
each partner specifying the number of gallons of each fuel
used during the tax year, the applicable credit per gallon, the
nontaxable use or sale, and any additional information
required to be submitted.
Additional Information
● Publication 378, Fuel Tax Credits and Refunds, has more
information on nontaxable uses and the definitions of terms
such as ultimate vendor and blocked pump.
● Publication 225, Farmer’s Tax Guide, also includes
information on credits for the federal excise tax on fuels.
● Notice 2005-4. You can find Notice 2005-4 on page 289 of
Internal Revenue Bulletin 2005-2 at
www.irs.gov/pub/irs-irbs/irb05-02.pdf.
● Notice 2005-24. You can find Notice 2005-24 on page 757
of Internal Revenue Bulletin 2005-12 at
www.irs.gov/pub/irs-irbs/irb05-12.pdf.
● Notice 2005-62. You can find Notice 2005-62 on page 443
of Internal Revenue Bulletin 2005-35 at
www.irs.gov/pub/irs-irbs/irb05-35.pdf.
● Notice 2005-80. You can find Notice 2005-80 in Internal
Revenue Bulletin 2005-46 at
www.irs.gov/pub/irs-irbs/irb05-46.pdf.
Recordkeeping
You must keep records to support any credits claimed on
this return for at least 3 years from the date the return is due
or filed, whichever is later.
Including the Fuel Tax Credit in Income
You must include in your gross income the amount of the
credit from line 15 if you took a deduction on your tax return
that included the amount of the taxes and that deduction
reduced your income tax liability. See Pub. 378 for more
information.
Specific Instructions
Complete all information requested for each claim you make.
You must enter the number (when requested) from the Type
of Use Table, the number of gallons, and the amount of
credit. If you need more space for any line (for example, for
more types of use), prepare a separate sheet using the same
format as the line.
Attach separate sheets showing any additional information
required for your claim such as the computation of the
amount to be credited. Be sure to write your name and
taxpayer identification number (TIN) on each sheet.
Amount of credit. For lines 1 through 14, multiply the rate
by the number of gallons. For lines 12 and 13, enter the
number of gallons of alcohol or biodiesel. Enter the result (or
the combined result as indicated by the brackets) in the
amount of credit column. Include amounts from any separate
sheets.
Annual Claims
If a claim was not made for any gallons during the income
tax year on Form 8849 or Form 720, an annual claim may be
made. Generally, an annual claim is made on Form 4136 for
the income tax year during which the fuel was used by the
ultimate purchaser, sold by the registered ultimate vendor,
used to produce an alcohol fuel mixture or biodiesel mixture,
or used in mobile machinery.

I.R.S. SPECIFICATIONS
INSTRUCTIONS TO PRINTERS
FORM 4136, PAGE 4 of 6
MARGINS: TOP 13mm (1⁄2 "), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
FLAT SIZE: 406mm (16")
279mm (11") folded to 203mm (8") X 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
Form 4136 (2005)
Claims for Fuel Destined for Export Including the
LUST Tax
Effective after September 30, 2005, claims cannot be made
for the LUST tax, except for fuel destined for export. The
affected credit rates have been reduced by $.001 to reflect
this change. Two rates are shown on various lines of Form
4136 with the * rate effective after September 30, 2005.
Taxpayers claiming the rate including the LUST tax for fuel
destined for export must attach a statement to Form 4136.
The statement should include the type of fuel, credit rate,
number of gallons, total credit, and proof of export. Include
any claims for fuel destined for export on the applicable line
of Form 4136.
Type of Use Table
The following table lists the nontaxable uses of fuels. You
must enter the number from the table in the Type of use
column on Form 4136.
No. Type of Use
1 On a farm for farming purposes
2 Off-highway business use (for business use other than
in a highway vehicle registered or required to be
registered for highway use)
3 Export
4 In a boat engaged in commercial fishing
5 In certain intercity and local buses
6 For diesel fuel or kerosene in a qualified local bus
7 In a bus transporting students and employees of
schools (school buses)
8 For diesel fuel and kerosene used other than as a fuel
in the propulsion engine of a train or diesel-powered
highway vehicle (but not off-highway business use)
9 In foreign trade
10 Certain helicopter and fixed-wing air ambulance uses
11 For aviation-grade kerosene used other than as a fuel in
the propulsion engine of an aircraft. Not valid as a type
of use after September 30, 2005
12 Not applicable
13 Exclusive use by a nonprofit educational organization
14 Exclusive use by a state, a political subdivision of a
state, or the District of Columbia
Line 1. Nontaxable Use of Gasoline
Claimant. The ultimate purchaser of the gasoline is the only
person eligible to make this claim.
Allowable uses. A claim cannot be made for personal use of
any fuel on line 1. Also, for lines 1a and 1c, a claim cannot
be made for any use in a motorboat, other than commercial
fishing.
For line 1a, the gasoline must have been used during the
income tax year for a business use other than in a highway
vehicle registered (or required to be registered) for highway
use (Type of use 2).
For line 1b, the gasoline must have been used during the
income tax year on a farm for farming purposes (Type of
use 1).
For line 1c, the gasoline must have been used during the
income tax year for type of use 3, 4, 5, 7, 13, or 14. For type of
use 13 or 14, claimant has not waived the right to make a claim.
Line 2. Nontaxable Use of Aviation Gasoline
Claimant: The ultimate purchaser of the aviation gasoline is
the only person eligible to make this claim.
Allowable uses. For line 2b, the aviation gasoline must have
been used during the period of claim for type of use 1, 3, 9,
10, 13, or 14. For type of use 13 or 14, claimant has not waived
the right to make a claim.
6
TO BE REMOVED BEFORE PRINTING
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Page 4
Line 3. Nontaxable Use of Undyed Diesel Fuel
Caution: Claims for undyed diesel fuel sold for use on a farm
for farming purposes after September 30, 2005 are made
only by the ultimate purchaser on line 3e. Line 3 cannot be
used to make a claim for diesel fuel used exclusively by a
state or local government. See line 6.
Claimant: The ultimate purchaser of the diesel fuel is the
only person eligible to make this claim.
Allowable uses. For line 3a, the diesel fuel must have been
used during the period of claim for type of use 2, 3, 6, 7, 8, or
13. For line 3e, see caution above. For line 3d, the claimant
has not waived the right to make a claim. Type of use 8 includes
use as heating oil and use in a motorboat.
Line 4. Nontaxable Use of Undyed Kerosene (Other Than
Aviation-Grade Kerosene and Kerosene Used in Aviation)
Caution: Claims for undyed kerosene sold for use on a farm
for farming purposes after September 30, 2005 are made
only by the ultimate purchaser on line 4c. Line 4 cannot be
used to make a claim for kerosene used exclusively by a state
or local government or for kerosene sold from a blocked
pump. See line 7.
Claimant: The ultimate purchaser of the kerosene is the only
person eligible to make this claim.
Allowable uses. For line 4a, the kerosene must have been
used during the income tax year for type of use 2, 3, 6, 7, 8,
or 13. For line 4c, see caution above. Line 4c does not
include claims for kerosene used in aviation for farming
purposes; instead, see line 14b. For line 4b, the claimant has
not waived the right to make a claim. Type of use 8 includes
use as heating oil and use in a motorboat.
You may claim a credit for the tax on undyed
kerosene you purchased (other than from a
TIP blocked pump) and used in your home during
2005 for heating, lighting, or cooking.
To claim the credit on line 4a for home use:
1. Enter 8 in col. (a).
2. Enter the number of gallons of kerosene in col. (c).
3. Multiply the gallons in col. (c) by $.244 ($.243 for gallons
after Sept. 30, 2005). Enter the result in col. (d).
4. If this is the only fuel tax credit you are claiming, enter
the amount from col. (d) on:
a. Line 15 of Form 4136, and
b. Line 70 of Form 1040. Also, check box b on line 70.
Line 5. Nontaxable Use of Aviation-Grade Kerosene,
Before Oct. 1, 2005
Caution: Line 5 cannot be used to make a claim for
aviation-grade kerosene used on a farm for farming purposes
or for exclusive use by a state or local government. Line 5
applies to claims for aviation-grade kerosene before October
1, 2005. See the line 14 instructions for kerosene used in
aviation after September 30, 2005.
Claimant: The ultimate purchaser of the aviation-grade
kerosene is the only person eligible to make this claim.
Allowable uses. For line 5b (other nontaxable use) the
aviation-grade kerosene must have been used during the
income tax year for type of use 3, 9, 10, 11, or 13. For line 5,
the claimant has not waived the right to make a claim.
Information for Claims on Lines 6-10
Registration number. To make an ultimate vendor claim on
lines 6-10, you are required to have a registration number.
Enter your registration number, including the prefix, on the
applicable line for your claim. If you do not have a
registration number, you cannot make a claim at this time.
Use Form 637, Application for Registration (For Certain
Excise Tax Activities), to apply for one.

I.R.S. SPECIFICATIONS
INSTRUCTIONS TO PRINTERS
FORM 4136, PAGE 5 of 6
MARGINS: TOP 13mm (1⁄2 "), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
FLAT SIZE: 406mm (16")
279mm (11") folded to 203mm (8") X 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
Form 4136 (2005)
Required certificate or waiver. The certificate for undyed
diesel fuel or undyed kerosene must contain all the
information as shown in the Model Certificate in Regulations
section 48.6427-9(e)(2).
Model certificates or waivers for sales of undyed diesel fuel
or undyed kerosene for use in certain intercity and local
buses, aviation-grade kerosene, gasoline, and aviation
gasoline can be found in Notice 2005-4 and Notice 2005-24.
Line 6. Sales by Registered Ultimate Vendors of Undyed
Diesel Fuel
Caution: Registered ultimate vendors cannot make claims for
diesel fuel sold for use on a farm for farming purposes after
September 30, 2005.
Claimant: For lines 6a (before October 1, 2005) and 6b, the
registered ultimate vendor of the diesel fuel is the only
person eligible to make this claim and has obtained the
required certificate from the buyer and has no reason to
believe any information in the certificate is false. For line 6c,
the registered ultimate vendor of the diesel fuel is eligible to
make a claim only if the buyer waives his or her right to
make the claim by providing the registered ultimate vendor
with an unexpired waiver. Only one claim may be filed with
respect to any gallon of diesel fuel. Enter your UV registration
number for line 6a or 6b. Enter your UB registration number
for line 6c.
Information to be submitted. For claims on lines 6a and 6b,
attach a separate sheet with the name and TIN of each
farmer, custom harvester, or governmental unit to whom the
diesel fuel was sold and the number of gallons sold to each.
Line 7. Sales by Registered Ultimate Vendors of Undyed
Kerosene (Other Than Aviation-Grade Kerosene and
Kerosene Used in Aviation)
Caution: Registered ultimate vendors cannot make claims for
kerosene sold for use on a farm for farming purposes after
September 30, 2005.
Claimant: For lines 7a (before October 1, 2005), 7b, and 7c,
the registered ultimate vendor of the kerosene is the only
person eligible to make this claim. For lines 7a and 7b,
claimant has obtained the required certificate from the buyer
and has no reason to believe any information in the
certificate is false. For line 7c, claimant has a statement, if
required, that contains: the date of sale, name and address
of the buyer, and the number of gallons of kerosene sold to
the buyer. For line 7d, the registered ultimate vendor of the
kerosene is eligible to make a claim only if the buyer waives
his or her right to make the claim by providing the registered
ultimate vendor with an unexpired waiver. Only one claim
may be filed with respect to any gallon of kerosene. Enter
your UV registration number for line 7a or 7b. Enter your UP
registration number for line 7c. Enter your UB registration
number for line 7d.
Exception. For the period October 1, 2005 – December 31,
2005, claims for kerosene used in aviation by a state or local
government are made using line 14b.
Information to be submitted. For claims on lines 7a and 7b,
attach a separate sheet with the name and TIN of each
farmer, custom harvester, or governmental unit to whom the
kerosene was sold and the number of gallons sold to each.
Line 8. Sales by Registered Ultimate Vendors of
Aviation-Grade Kerosene
Caution: Line 8 applies to claims for aviation-grade kerosene
before October 1, 2005. See the line 14 instructions for
kerosene used in aviation after September 30, 2005.
Claimant. For lines 8a and 8b, the registered ultimate vendor
of the aviation-grade kerosene is eligible to make this claim
only if the buyer waives his or her right by providing the
6
TO BE REMOVED BEFORE PRINTING
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INK: BLACK
Page 5
registered ultimate vendor with an unexpired waiver. For lines
8c and 8d, the registered ultimate vendor of the
aviation-grade kerosene is the only person eligible to make
this claim and has obtained the required certificate from the
buyer and has no reason to believe any information in the
certificate is false. Only one claim may be filed with respect
to any gallon of aviation-grade kerosene. Enter your UA
registration number for lines 8a and 8b. Enter your UV
registration number for lines 8c and 8d.
Allowable sales. For line 8b, the aviation-grade kerosene
must have been sold during the income tax year for type of
use 3, 9, 10, or 13.
Information to be submitted. For claims on lines 8c and 8d,
attach a separate sheet with the name and TIN of each
farmer, custom harvester, or governmental unit to whom the
aviation-grade kerosene was sold and the number of gallons
sold to each.
Line 9. Sales by Registered Ultimate Vendors of Gasoline
Claimant. The registered ultimate vendor of the gasoline is
eligible to make a claim on lines 9a and 9b if the buyer
waives his or her right to make the claim by providing the
registered ultimate vendor with an unexpired certificate. Only
one claim may be filed with respect to any gallon of gasoline.
Registration number. Enter your UV registration number for
line 9a or 9b.
Information to be submitted. For claims on lines 9a and 9b,
attach a separate sheet with the name and TIN of each
nonprofit educational organization or governmental unit to
whom the gasoline was sold and the number of gallons sold
to each.
Line 10. Sales by Registered Ultimate Vendors of Aviation
Gasoline
Claimant. The registered ultimate vendor of the aviation
gasoline is eligible to make a claim on lines 10a and 10b if
the buyer waives his or her right to make the claim by
providing the registered ultimate vendor with an unexpired
certificate. Only one claim may be filed with respect to any
gallon of aviation gasoline.
Registration number. Enter your UV registration number for
line 10a or 10b.
Information to be submitted. For claims on lines 10a and
10b, attach a separate sheet with the name and TIN of each
nonprofit educational organization or governmental unit to
whom the aviation gasoline was sold and the number of
gallons sold to each.
Line 11. Nontaxable Use of Liquefied Petroleum Gas
(LPG)
Allowable uses. For line 11(c), the taxed LPG must have
been used during the income tax year for type of use 1, 2, 4,
13, or 14.
Information for Claims on Lines 12 and 13
If you make a claim for alcohol or biodiesel used to produce
an alcohol fuel mixture or a biodiesel mixture, a claim on
Form 4136 can only be made for the amount that exceeds
your taxable fuel liability reported on Form 720 for any
particular quarter. See Notice 2005-4 and Notice 2005-62 for
more information.
Line 12. Alcohol Fuel Mixture Credit
Claimant. The person that produced and sold or used the
mixture is the only person eligible to make this claim. The
credit is based on the gallons of alcohol in the mixture.

I.R.S. SPECIFICATIONS TO BE REMOVED BEFORE PRINTING
INSTRUCTIONS TO PRINTERS
FORM 4136, PAGE 6 of 6
MARGINS: TOP 13mm (1⁄2 "), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
FLAT SIZE: 406mm (16")
279mm (11") folded to 203mm (8") X 279mm (11")
PERFORATE: ON FOLD
DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT
Form 4136 (2005)
Line 13. Biodiesel Mixture Credit
Claimant. The person that produced and sold or used the
mixture is the only person eligible to make this claim. The
credit is based on the gallons of biodiesel in the mixture.
Certificate. For biodiesel sold or used after August 29, 2005,
you may have to attach the Certificate for Biodiesel and, if
applicable, Statement of Biodiesel Reseller, to the Form
4136. See Notice 2005-62 for more information.
Line 14. Kerosene For Use in Aviation, After
September 30, 2005
Caution: Line 14 applies to claims for kerosene used in
aviation after September 30, 2005. See lines 5 and 8 for
aviation-grade kerosene claims before October 1, 2005.
Note. First compute the credit by using the lines below, then
enter the amount of the credit on Form 4136, line 14a or
14b. Keep the worksheet for your records.
1 Kerosene taxed at $.244
2 Kerosene taxed at $.219
Total. Enter the amount of the credit here and on line 14a of Form 4136
Line 14b. Sales by registered ultimate vendors
Claimant. For lines 1 and 2 below, the registered ultimate
vendor of the kerosene for use in aviation is eligible to make
this claim only if the buyer waives his or her right by
providing the registered ultimate vendor with an unexpired
certificate. For lines 3, 4, and 5 below, the registered ultimate
vendor of the kerosene for use in aviation is the only person
eligible to make this claim and has obtained the required
1 Use in commercial aviation (other than foreign trade)
taxed at $.219
2 Use in commercial aviation (other than foreign trade)
taxed at $.244
3 Nonexempt use in noncommercial aviation
4 Other nontaxable uses taxed at $.244
5 Other nontaxable uses taxed at $.219
Total. Enter the amount of the credit here and on line 14b of Form 4136
Paperwork Reduction Act Notice. We ask for the
information on Form 4136 to carry out the Internal Revenue
laws of the United States. We need it to ensure that you are
complying with these laws and to allow us to figure and
collect the right amount of tax.
You are not required to provide the information requested
on a form that is subject to the Paperwork Reduction Act
unless the form displays a valid OMB control number. Books
or records relating to a form or its instructions must be
retained as long as their contents may become material in
the administration of any Internal Revenue law. Generally, tax
returns and return information are confidential, as required by
section 6103.
6
PRINTS: HEAD TO HEAD
INK: BLACK
Page 6
Line 14a. Used in commercial aviation (other than foreign
trade)
Claimant: The ultimate purchaser of the kerosene used in
commercial aviation (other than foreign trade) is eligible to
make this claim. For lines 1and 2 below, claimant certifies
the right to make the claim has not been waived. For line 2
below, claimant may purchase kerosene partly for use in
domestic commercial aviation and partly for use in
noncommercial aviation. If the claimant does not identify the
amount of kerosene that will be used in commercial aviation,
the claimant may provide a certificate to the ultimate vendor
with the “for a nonexempt use in noncommercial aviation”
line checked. The operator can make a claim for $.175 per
gallon for the kerosene used in domestic commercial
aviation. The ultimate vendor can make a claim for $.025 per
gallon using line 14b below. See Notice 2005-80 for a model
certificate.
(b) Rate (c) Gallons (d) Amount of credit
$.200 $
.175
䊳
certificate from the ultimate purchaser. For types of use 1, 9,
10, or 13, see Notice 2005-80 for a model certificate. For
type of use 14, see Model Certificate B in Pub. 378 or Model
Certificate P in Pub. 510. Write your UA registration number
in the blank space on line 14b.
Allowable sales. For lines 4 and 5, the kerosene for use in
aviation must have been sold during the income tax year for
type of use 1, 9, 10, 13, or 14.
(a) Type of use (b) Rate (c) Gallons (d) Amount of credit
$ .175 $
.200
.025
.243
.218
䊳
The time needed to complete and file this form will vary
depending on individual circumstances. The estimated
burden for individual taxpayers filing this form is approved
under OMB control number 1545-0074 and is included in the
estimates shown in the instructions for Form 1040. The
estimated burden for all other taxpayers is shown below.
Recordkeeping, 19 hr., 46 min.; Learning about the law or
the form, 6 min.; Preparing and sending the form to the
IRS, 20 min.
If you have comments concerning the accuracy of these
time estimates or suggestions for making Form 4136 simpler,
we would be happy to hear from you. You can write to the
Internal Revenue Service at the address listed in the
instructions of the tax return with which Form 4136 is filed.